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Fractional Flow Reserve (FFR) coding, additional vessel

Carl Posted Wed 27th of January, 2016 03:02:38 AM

Dx: I20.0 I25.10 Z95.5

The patient has documented CAD with previous angioplasty and drug eluting stents (2012).
He has recurrence of chest pain and angina pectoris.
He underwent (2015/10/29) left heart catheterization, selective coronary angiography and left ventriculography.
Two vessel Fractional flow reserve measurement (FFR) was obtained in the LAD and RCA.
Right radial vascular access.

CPT: 93458, +93571-LD, +93572-RC

Is the CPT coding correct?
Thanks

SuperCoder Answered Thu 28th of January, 2016 01:30:24 AM

Hi,

Yes I think you are coding appropriately.

Thanks

Carl Posted Wed 06th of July, 2016 03:10:17 AM
I received from billing that Medicare does not cover add-on codes (+93572). Is it true?
SuperCoder Answered Thu 07th of July, 2016 03:08:48 AM
Hi, From the information I've seen, 93458 should be an OK primary code for 93571. For example, in LCD L26880, "Cardiac Catheterization and Coronary Angiography," NGS says, "Intracoronary ultrasound may be separately covered when needed to assess the extent of coronary stenosis if equivocal on angiography, or when needed to assess the patency and integrity of a coronary artery post-intervention. Alternatively, intravascular Doppler velocity and/or pressure derived coronary FLOW RESERVE measurement may be performed to assess the degree of stenosis within a vessel. Only intracoronary ultrasound or functional FLOW RESERVE measurement should be performed on an individual artery, so that both services performed on the same artery will not be reimbursed." (By the way, NGS article A50603 says to use RC, LC, or LD with 93571. But from what other coders have said, that requirement can vary by payer.) If your payer has a different preference. Also,I could not find any source that 93572 is not covered by medicare. Codes +93571 and +93572 are add-on codes, as the “+” before the codes indicates. The CPT manual’s “Introduction” explains that “add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code.” As per below link 93572 is a Status C code(Status C are priced by each contractor. CGS establishes RVUs and payment amounts for these services, generally on an individual basis,based on review of documentation (such as operative reports) https://www.cgsmedicare.com/pdf/j15_fee_schedules_2015.pdf

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